Impact of Neoadjuvant Chemotherapy on Pathological Outcomes and Survival in Muscle-Invasive Bladder Cancer: A Single-Center Retrospective Analysis

Neoadjuvant chemotherapy (NAC) is recommended for patients with muscle-invasive bladder cancer (MIBC); however, its impact on survival outcomes remains controversial in real-world clinical settings. This retrospective observational study evaluated the effect of NAC on pathological outcomes and overall survival among patients who underwent radical cystectomy between January 2015 and December 2025. A total of 78 patients were included and stratified by receipt of NAC. Overall survival (OS) was assessed using Kaplan–Meier analysis, and independent predictors of mortality were evaluated using multivariable Cox regression. Among the patients, 20 (25.6%) received NAC and 58 (74.4%) did not. NAC was associated with higher ratesof pathological downstaging (60.0% vs 27.6%, p=0.009) and lower rates of lymph node involvement (15.0% vs 41.4%, p=0.032). Although Kaplan–Meier analysis demonstrated no significant difference in OS between groups (log-rank p>0.05), NAC was associated with a lower risk of mortality in the adjusted Cox regression model (HR: 0.29, p=0.005); however, this finding should be interpreted cautiously because of the limited sample size and low event-per-variable ratio. Tumor size ≥3 cm (HR: 4.76, p=0.001) and tumor multiplicity (HR: 4.17, p=0.001) were independent predictors of worse survival. NAC was associated with improved pathological outcomes and a lower risk of mortality in the adjusted model; however, survival findings should be interpreted cautiously because of the limited sample size, low event-per-variable ratio, and potential selection bias.